The Lomidine Files: The Untold Story of a Medical Disaster in Colonial Africa

By Guillaume Lachenal

This prize-winning study examines the nightmarish effects of the so-called “wonder drug” in preventing sleeping sickness in Africa.

After the Second World War, French colonial health services set out to eradicate sleeping sickness in Africa. The newly discovered drug Lomidine (also known as Pentamidine) promised to protect against infection, and mass campaigns of “preventive lomidinization” were launched across Africa. But the drug proved to be both inefficient and dangerous. In numerous cases, it led to fatality.

In The Lomidine Files, Guillaume Lachenal traces the medicine’s trajectory from experimental trials during the Second World War to its abandonment in the late 1950s. He explores colonial doctors’ dangerous obsession with an Africa freed from disease and describes the terrible reactions caused by the drug, the resulting panic of colonial authorities, and the decades-long cover-up that followed.

A fascinating material history that touches on the drug’s manufacture and distribution, as well as the tragedies that followed in its path, The Lomidine Files resurrects a nearly forgotten scandal. Ultimately, it illuminates public health not only as a showcase of colonial humanism and a tool of control but also as an arena of mediocrity, powerlessness, and stupidity.

Winner of the George Rosen Prize by the American Association for the History of Medicine

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Oct 1, 2017
• ISBN: 9781421423241

Book preview

The Lomidine Files

The Lomidine Files

The Untold Story of a Medical Disaster in Colonial Africa

Guillaume Lachenal

Translated by Noémi Tousignant

Originally published as Le médicament qui devait sauver l’Afrique. Un scandale pharmaceutique aux colonies

© Éditions La Découverte, Paris, France, 2014

Translation © Johns Hopkins University Press, 2017

All rights reserved. Published 2017

Printed in the United States of America on acid-free paper

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Library of Congress Cataloging-in-Publication Data

Names: Lachenal, Guillaume, 1978–, author.

Title: The Lomidine files: the untold story of a medical disaster in colonial Africa / Guillaume Lachenal; translated by Noémi Tousignant.

Other titles: Médicament qui devait sauver l’Afrique. English | Lomidine scandal and treating sleeping sickness in Africa

Description: Baltimore: Johns Hopkins University Press, 2017. | Translation of: Le médicament qui devait sauver l’Afrique : un scandale pharmaceutique aux colonies / Guillaume Lachenal. Paris : La Découverte, 2014. | Includes bibliographical references and index.

Identifiers: LCCN 2016051704| ISBN 9781421423234 (hardcover : alk. paper) | ISBN 9781421423241 (electronic) | ISBN 1421423235 (hardcover : alk. paper) | ISBN 1421423243 (electronic)

Subjects: | MESH: Trypanosomiasis, African—drug therapy | Pentamidine—adverse effects | Colonialism—history | Ethics, Medical—history | History, 20th Century | Africa | France

Classification: LCC RA644.T69 | NLM WC 705 | DDC 614.5/33—dc23 LC record available at https://lccn.loc.gov/2016051704

A catalog record for this book is available from the British Library.

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Contents

Introduction: An Anthropology of Colonial Unreason

1   The Wonder Drug

2   Experiments without Borders

3   The New Deal of Colonial Medicine

4   The Spectacle of Eradication

5   Lomidine, the Individual, and Race

6   Good Citizens and Bad Brothers

7   Yokadouma, Cameroon, November–December 1954

8   We Cried without Making a Palaver

9   The Misfires of the Imperial Machine

10   The Swan Song of Eradication

11   How the Drug Became Useless and Dangerous

Epilogue

Acknowledgments

List of Abbreviations and Acronyms

Notes

Index

The Lomidine Files

INTRODUCTION

An Anthropology of Colonial Unreason

In the early morning of November 12, 1954, the Service d’hygiène mobile et de prophylaxie (Mobile Hygiene and Prophylaxis Service) made its annual stop in Gribi, a village in eastern Cameroon. All the villagers, women and children included, gathered, as they did every year, for their injection of Lomidine. The preventive administration of Lomidine to entire populations, then called total Lomidinization, was a priority and a source of pride for the postwar colonial health services. The technique’s efficacy was unprecedented: a single injection of Lomidine conferred protection for several months against infection by trypanosomes, the parasites that cause sleeping sickness. In the face of an epidemic disease considered to be the main obstacle to demographic growth and to the project of mise en valeur¹ in the African colonies, this new strategy kindled great hope. Now, for the first time, eradication was within reach. Indeed, no new cases of the disease had been reported in the Gribi area in 1954.

The team worked efficiently. In just two days, four nurses surveyed, examined, and Lomidinized more than a thousand individuals. On the evening of November 13, a European health assistant by the name of Ansellem left Gribi to spend the night in the nearby regional capital of Yokadouma, 30 kilometers away.

An unexpected event interrupted his evening rest: a truck arrived carrying a resident of Gribi who complained of a painful abscess in the buttocks, which appeared to have resulted from the Lomidine injection. Ansellem did not seem worried by the incident and kept to the plan for the tour. The following morning, his team Lomidinized another three hundred people in a neighboring village. Later that day, however, the news from Gribi was alarming: three individuals had died, and another dozen, all Lomidinized two days earlier, had developed worrisome abscesses. During the evening, a truck arrived: its twenty-one passengers were in critical condition. Their buttocks and thighs were very swollen, and there were signs of putrefaction and bursting in their muscles; their general state was very altered. During the night, two patients died. Four or five fell into a coma.

The death toll climbed by the hour. A catastrophe was looming, and the diagnosis was soon obvious: the shot of Lomidine had caused a bacterial infection that progressed to gas gangrene, spreading from the buttock to the rest of the body, leading to swelling and bursting in affected tissues. Despite the arrival of medical backup on November 15, the accident of Yokadouma resulted in a total of more than three hundred cases of gangrene and thirty-two deaths—one of the most violent medical catastrophes in African history.

This book is a biography of Lomidine. It traces this medicine’s trajectory from its first trials during the Second World War, when it was introduced as a miracle cure for sleeping sickness, to its abandonment in the late 1950s, when a series of incidents in Gribi and elsewhere brought Lomidinization campaigns to a grinding halt. My broader aim, however, is more ambitious: by selecting as a historical object this white powder, a powder injected more than ten million times in Africa during the 1950s, I am experimenting with a novel form of inquiry into the relation between medicine and colonialism. Considering this drug as a therapeutic agent, a technology of government, a commodity as well as an object of expertise, belief, storytelling, and controversy and by tracking its history as it unfolded, I seek to study medicine as a tool of colonial power and as the stage of its legitimation—and its contestation. Inverting this relation, I seek in addition to understand the imperial dimension of the biomedical revolution of the second half of the twentieth century.

Lomidine’s history opens a window onto the daily life of the colonial modernization program implemented after World War II, revealing its underside: its racial logics, coercive apparatus, and constitutive inefficacy along with the unreason inherent in its characteristic principles of rationality, authority, and evidence—what I call their bêtise (this term is discussed in more detail below). From sanitary utopia to health catastrophe, the history of Lomidine lays bare the messianic, mediocre, enthusiastic, and obstinate contribution of medicine to European imperialism. It allows for a reexamination of the colonial dream of an Africa liberated from disease and of the hopes and lives left in its wake.

An Awkward Ruin

I will start this story where it ends: in the late 2000s in eastern France, on the bank of the Doubs in the middle of the industrial wasteland of the Rhodiacéta factory—known to the locals as la Rhodia. During the Trente Glorieuses (Glorious Thirty),² Rhodia was among the landmark textile factories of Rhône-Poulenc, then the biggest chemical and pharmaceutical firm in France. With more than three thousand workers producing nylon and other synthetic fibers in the 1960s, the factory was the region’s industrial pride and glory and an exemplary site of French-style Fordism—as well as of its contestation in 1967–68. Hit hard by the oil crisis and by the ensuing corporate restructuring, the factory closed its doors in the early 1980s, after several business plans and as many promises of recovery and revitalization.³ All that is left of Rhodia’s glorious past in Besançon is a huge, cumbersome ruin, too much trouble to destroy and too expensive to restore.

A single functional building remains. It houses the Société d’archivage moderne (Society for Modern Archiving; SAM), a company specializing in the stocking, conservation and destruction of archives, according to its website.⁴ Created when Rhodia closed, the SAM now employs about twenty workers, several of whom were reclassified from jobs in the former factory; the archivist who received me, for example, was formerly a Tergal spinner. Thus, all that is left of Rhodia is a modest archiving company; it is as if the act of archiving this history operates as both a continuation and a parody of factory work. The SAM inherited part of the archives of the Rhône-Poulenc corporation, which became Aventis, then Sanofi, after a series of mergers, dissolutions, and acquisitions. Among these archives I found three precious boxes: they contained the only files I could access on Lomidine from its former manufacturer, then one of the world’s biggest pharmaceutical firms.

The files came from the Usines du Rhône (Rhône Factories) in Saint-Fons near Lyons, where Lomidine powder was processed and packaged. They record a thousand minutely detailed debates about the best ways of filling, stoppering, labeling, wrapping, storing, and shipping, mainly to Africa, flasks and ampules of Lomidine. These are tedious questions that no one, not even specialists, are interested in today. But they were questions of life or death, as we will see, on a November day in 1954 in Gribi, eastern Cameroon.

I begin this book with these archives, even though I read them—after several years spent looking for and then gaining access to them—at the very end of my investigation. Because of their content, form, and current status, these archives allow me to articulate some of the fundamental ideas underlying my project. They speak, above all, of material matters—of the smell and texture of a powder, its dust and impurities, of the aesthetics of a label and the fragility of a flask. These issues lie at the heart of my inquiry: to proceed by way of materiality is, for me, a research strategy that allows for the circumvention of the historiographical cliché of an encounter between colonizer and colonized,⁵ and this strategy allows me to locate myself beyond texts and the language of colonial experts. These archives also reveal a need to think of colonial medicine in Africa beyond the borders of each European empire: the collected correspondence traces a transnational and inter-imperial network, connecting the secretariat of one of France’s biggest chemical factories with Portuguese Angola, the Belgian Congo, and French Guinea via Vitry-sur-Seine, Léopoldville, and Liverpool; this network was simultaneously commercial, medical, and scientific. Finally, these archives speak of the passage of time, of what lasts and of what vanishes beyond political history’s major watersheds. With its gutted walls, old machines, and factory workers turned into archivists, the Rhodia wasteland is a ruin of modernity that both describes and parodies the hopes and projects of France’s era of modernization. More unexpectedly, the Lomidine files kept, somewhat accidentally, in the last of its buildings also make Rhodia an improbable remnant of empire, which sets the Trente Glorieuses of French science and industry against their imperial and African backdrop.⁶

Biography of Debris

Like Rhodia, Lomidine is a troublesome ruin, debris of empire. Lomidine (also known by the name of Pentamidine) is a surprising, but not necessarily an exceptional, case in medical history.⁷ Throughout the 1950s, it was seen as a miracle drug, an emblem of modern medicine in Africa, and it was administered preventively and compulsorily to entire regions. Beginning in the late 1960s, however, its status radically changed. After two decades of mass campaigns punctuated by horrific therapeutic accidents, a series of laboratory experiments completely revised the state of knowledge on the drug’s efficacy and safety—and even its mode of action. A consensus was reached, which remains undisputed: Lomidine has no preventive effects. It does not protect (or at least not very well, certainly not for several months) healthy individuals, and it exposes those individuals to unacceptable risks, particularly for the heart. This does not imply that Lomidinization campaigns played no role in arresting the epidemic progression of sleeping sickness; the drug did, apparently, contribute to the interruption of transmission at the population level—though this is not how its mechanism was understood at the time. Yet as the prospect of eradication definitively receded, preventive Lomidine came to be seen as a pointless, dangerous, and thus pointlessly dangerous technique, in the words of French doctor René Labusquière, one of the major postwar figures of the colonial medical corps.⁸ After such a reversal, the moment of glory of total Lomidinization has become difficult to comprehend and even to narrate, which may explain why historians have remained so silent about it. Lomidinization, which was erected as a monument to the colonial health enterprise in the 1950s, had to then be erased from official histories of tropical medicine. What remains are carefully archived shelves full of publicity brochures, reports, correspondence, medical theses, conference proceedings, and field manuals describing Lomidinization campaigns. The wonder drug has become embarrassing: too awkward for the hagiographers and too technical or anecdotal for critical historical narratives.

Rhodia wasteland, Besançon, 2008. Photos by author.

Retrospectively, Lomidinization appears to be a technique that worked but for the wrong reasons; the therapeutic rationale, to borrow current terminology, has revealed itself to be a public health strategy based on mere faith. By giving away the denouement of the plot from the outset, my goal is not to expose colonial doctors as having operated under an illusion, as having been mistaken about Lomidine, and thus to write what Bachelard called a judged history.⁹ I seek instead to make heuristic use of the retrospective judgment on Lomidine. How is it possible to understand its obvious success, doctors’ enthusiasm for it, and its routine use in mass campaigns, when we now know that Lomidine is an extremely tricky drug to handle, that it does not work preventively, and that it is very painful when injected—an example of what French clinicians call a cochonnerie: a nasty, difficult, yet indispensable drug?¹⁰ This question might be accused of anachronism: historians, in such situations, often opt for the pretense of being unaware of what we now know in order to avoid writing history backward.¹¹ Yet at the risk of shocking, the end of the story guides my inquiry because it spurs attentiveness—perhaps a bit more than usual—to the (in)efficacy of the drug itself as an unstable, material substance; to its prodigious successes and its misfires; to its agency; and to how this agency destabilized or reassured the drug’s proponents, or left them indifferent.¹²

This approach places the incoherence of daily practice at the center of an inquiry on the processes that afforded coherence and strength to colonial medical power. How did colonial experts understand and resolve—by sometimes violent means—the uncertainties and fragility of their own techniques and programs? What world views, what technical and scientific calculations, what ethical and political choices allowed—even as contradictions, problems, and resistance arose—for the determined and enthusiastic implementation of Lomidinization, which indeed grew even more determined and enthusiastic as contradictions, problematic incidents, and resistance arose? To put it more crudely: How did it become possible and acceptable for thirty-two people to die in Gribi, near Yokadouma, on a single day in November 1954 after they were injected with a medicine that was already (half-)known to not really protect against a disease that, in any case, was no longer present in the area? My project is thus both a biography of a technoscientific object and a historical anthropology of colonial unreason.

Lomidine and the Colonial Disease

The biography of Lomidine sheds light on a relatively unknown but crucial phase in the colonial control of sleeping sickness—an epidemic that has played a major role in African history. Sleeping sickness (African human trypanosomiasis) is a parasitic infection caused by a trypanosome and transmitted by the tsetse fly (glossina);¹³ it is prevalent in intertropical Africa in a band that stretches from Senegal to Lake Victoria. Its common name refers to the neurological and psychiatric symptoms associated with the advanced stages of the disease. Sleeping sickness was defined as a health priority by the colonial states of Central Africa in the first years of the twentieth century. At that time, the disease, then of unknown etiology, grew to epidemic proportions, particularly in the Great Lakes region and the Congo Basin. This unprecedented outbreak was both a symptom and a result of the social, ecological, and demographic crisis caused by colonial conquest in this region; classic estimates suggest that Central Africa lost half of its population between 1880 and 1910.¹⁴

Mobilization against this epidemic stimulated the birth and institutionalization of tropical medicine as a discipline in both Europe and the colonial world. A series of expeditions and study missions was organized, both in collaboration and in competition, by a loose set of semi-public institutions, such as the Institut Pasteur (Pasteur Institute) and the Liverpool School of Tropical Medicine, and by scientific societies, colonial lobbyists, eminent scientists such as the German Robert Koch, and private individuals like King Leopold. Their findings provided a basis for determining the etiological and clinical profile of the disease.¹⁵ In just a few years, between 1902 and 1907, researchers managed to identify the disease’s parasite, vector, and animal reservoir and to describe its course in humans, beginning with a first stage lasting up to several years during which few perceptible symptoms appear, then progressing, with highly variable speed and intensity from one individual to another, to a more severe, eventually fatal affliction. The microbe hunt led by European scientists and the ensuing initial therapeutic successes were given a high public profile. The tsetse fly thus became a familiar figure of colonial propaganda; along with the image of the pith-helmeted doctor hunched over a microscope, it made its way into the textbooks of metropolitan schoolchildren.¹⁶

Historians have displayed great interest in the large-scale sleeping sickness control programs deployed from Upper Volta to Tanganyika during the interwar period.¹⁷ These programs varied in form, over time, and according to context, alternately targeting the tsetse fly, animal reservoirs, population movements, or the parasite itself through chemotherapy. Yet they all shared a particularly ambitious conception of public health, relying on a centralized, coercive, and militarized apparatus. In some rural areas, sleeping sickness interventions were the main expression of the colonial state; they also inspired the pursuit of sanitary utopias, in which medical action took on the features of a social engineering project.¹⁸ By mobilizing hundreds of doctors and thousands of African auxiliaries across European empires, the control of sleeping sickness also catalyzed the emergence of an imperial medical profession—called la trypano in francophone areas—and the creation of a specific professional corps, with its own rituals and heroes, such as Eugène Jamot.¹⁹

The populations of affected zones were summoned to compulsory sessions of diagnostic screening and treatment, particularly in the Belgian Congo, Cameroon, Afrique occidentale française (French West Africa; AOF), and Afrique équatoriale française (French Equatorial Africa; AEF). These mass campaigns were experiments with an innovative form of standardized collective medicine; they had, at the time, no equivalents in the imperial metropoles in France or Belgium. If the epidemic itself, triggered by the scramble for Africa of the late nineteenth century, was in a way the colonial disease par excellence, the campaigns launched to control it similarly constituted an archetype of colonial medicine. They were a mode of medical practice that prescribed colonial order as much as they were produced by it.²⁰ By making the management of the population—as both biological entity and human capital—their objective and horizon, these campaigns engaged in a pure form of biopolitics, as defined by Michel Foucault. Their ambition and logics anticipated (and in some cases directly contributed to) the racial turn in European biopolitics of the 1930s and 1940s.²¹

The control of sleeping sickness was photogenic and spectacular; it later became a topic of prolific memorial production, proffering figures and stories to both revisionist and apologist historians of the colonial enterprise; Niall Ferguson, for example, used (inaccurately captioned) photos of Dr. Jamot in his TED Talk.²² This battle against disease was not only a fascinating feature of imperial cultures, it is also embedded in the genealogy of contemporary humanitarianism. During the sleeping sickness campaigns, photos on glossy paper of gaunt African children circulated for the first time—such images would have a long shelf life in the European media—while the laid-back yet sophisticated figure of the French doctor, fighting an ever-losing battle against disease, African ignorance, and Western bureaucracy, also made his first appearance.²³

Lomidine has been a forgotten player in all this. Histories of sleeping sickness generally focus on the monumental actors of the interwar era, with the period after 1945 tacked on as an epilogue. Chronicles of medical progress do note that Lomidine revitalized an aging therapeutic arsenical, which, until the 1940s, was limited to rather toxic, arsenic-based trypanocide molecules. Yet the radical novelty of its preventive use (what is now called chemoprophylaxis) is rarely pointed out. Lomidinization accidents, the accepted euphemism at the time, are known today by only a handful of tropical medicine specialists.²⁴

This omission is especially surprising given that Lomidinization and its accidents happened during sleeping sickness control’s moment of triumph, at a time when imminent eradication was announced on a regular basis. This was also a time of new problems, however, as the liberalization of colonial regimes recast authoritarian modes of population management as an increasingly sensitive issue. The 1950s were a golden age for colonial medicine, which was bolstered by unprecedented technical means and political will; yet the ’50s were also a decade of tensions and violence in French colonies as well as in Belgian, British, and Portuguese Africa. Never before had colonial sanitary utopianism been pushed further in its logic and contradictions. The biography of Lomidine is a narrative thread with which to grasp late colonialism as a moment of both reform and reaction, when racial hierarchies were simultaneously undermined and reaffirmed.

The Empire of Bêtise

Historians often describe colonial medicine as an instrument for the rational ordering of the colonized world, imposing its hierarchies, values, and identities onto people and things. Colonial medicine, which became a scientific discipline of its own, did indeed serve as an ideology and tool of empire: by embodying the mission civilisatrice (civilizing mission), by facilitating military conquest, and by protecting the health of colonists. It was also a strategic site of intervention into colonized societies, a form of government of bodies and populations that, in its reach, far exceeded the goal of controlling disease. In the field of medicine, the colonies were even considered in situ laboratories, sites for the testing of therapeutic, urbanist, and bureaucratic techniques to be reimported to the metropole.²⁵

Yet the case of Lomidine does not fully align with this critical, Foucault-inspired reading.²⁶ There are several reasons such a reading would be incomplete. First, there was, as historians such as Fred Cooper remind us, a gulf between colonial intentions and realizations, and the great biopolitical projects often got mired in the lack of means and the internal tensions of colonial states.²⁷ Above all, such an analysis, by taking doctors at their words, would completely miss what Achille Mbembe describes as the contribution of ‘misfires,’ of the unexpected and of ‘disorder’ , which were at the heart of the colonial disciplinary project; this dimension, he points out, has until now been reconstructed with an impressive lack of precision.²⁸

Lomidine opens up an approach to colonial history that takes a misfire as its point of departure; its history is that of a mediocre medicine, which would fail even to provoke scandal. Lomidine was a drug that did not really work—or, to put it a bit differently, that worked a little, but not for the right reasons. It is precisely because Lomidine could not protect individuals per se that it was prescribed for application to entire regions until it became a medicine for the race, one that was evaluated and administered—if needed, by force—;exclusively on a collective scale. Its misfires were obvious to doctors, but they were also galvanizing. To account for this episode, it is difficult to rely on the categories usually mobilized by historians, who are inclined to speak of the colonies as an ordered world, dominated by reason and colonial law, or to describe colonial doctors, in the manner of Bruno Latour and of science studies, as archetypal embodiments of the scientist-entrepreneur, at once producers of knowledge and reformers of society.²⁹ The minor history of Lomidine introduces disorder and doubt into such grand narratives: it poses the question of how to characterize what looks, retrospectively, like a colossal failure, which was promoted in real time with an arrogance that seems difficult to take seriously today.

The case of Lomidine invites another way of telling the history of science and of colonial medicine. The idea is not only to keep pointing out—against a somewhat naïve, or fascinated, reading of biopolitical projects—the thousand contradictions and setbacks of colonial modernization but also to reexamine what has been left out of the historical field of vision: the constitutive powerlessness, hubris, and irrationality of colonial government. The existing gap in historiographical thinking is particularly puzzling considering that the rational dimension of colonial policies was systematically criticized from the very start: colonists themselves mocked the life-size experiments (one of doctors’ favorite phrases), pilot projects, and other ambitious undertakings of colonial mise en valeur, not to mention their perplexed and incredulous interpretation by colonized subjects.³⁰ Literature has been particularly inclined to critiques of colonial and scientific megalomania, echoing broader judgments about experimental medicine, including colonial medicine.³¹ Surprisingly, this often humorous and sometimes despairing reflexive dimension of colonial modernity has been completely neglected by scholars, who seem to be the only ones left who believe in colonial doctors’ demiurgic power to discipline bodies and order the world.³²

In this book, I launch an inquiry into the negatives that worked within colonial logic, which made it a reason that was at once religious, mystical, messianic, military and utopian, as Mbembe puts it.³³ The goal is not to stage a romantic confrontation between other systems of thought and action and Western rationality, embodied in the imposition of grids on indigenous spaces and societies. Rather, I seek to give an account of the double structure of ignorance and impotence in which the colonial will to know and to intervene was embedded.³⁴ There are several possible ways of turning on its head the description of an omniscient, omnipotent, and rational colonial power. One is to reexamine the way in which it cultivated ignorance,³⁵ even madness, to move, as Johannes Fabian proposes, the critique of colonialism from questions of guilt to questions of error.³⁶ Another is to attend, as Warwick Anderson and Nancy Hunt do, to how the nerves of colonial agents,³⁷ especially doctors, were harshly tested, to the extent of stimulating the emergence of a specialized medicopsychiatric infrastructure—and publishing industry—in both colonies and metropoles.³⁸ As Fabian shows in his counterhistory of late nineteenth-century Africanist ethnology, the colonial operation of ordering the African continent was often carried out by scientists who were exhausted, intoxicated, and knocked out by fever, whose ways of knowing deviated, to put it mildly, from cold rationality.³⁹ This body of work suggests that the colonial knowledge regime was anchored as much in a culture of ignorance and inaction as it was in the quest for order and scientific facts that historians have so prolifically written about.

In this book, I am interested in